Date Presented 03/26/20
The relationships between COPM outcome scores and severity levels on the Gross Motor Function Classification System (GMFCS) and the Manual Ability Classification System (MACS)/Mini-Manual Ability Classification System (Mini-MACS) were examined. The findings may have meaningful impact in providing evidence for future research studies as well as best practices in OT services for individuals with cerebral palsy.
Primary Author and Speaker: Lora Woo
Contributing Authors: Elizabeth Russel, Caleb Lyu
PURPOSE: The Canadian Occupational Performance Measure (COPM) is a patient/family driven assessment tool to identify problems in occupational performance. The COPM measures changes in patient/family perception of occupational performance over the course of occupational therapy intervention.1 The Gross Motor Function Classification System (GMFCS) is a five-level classification system that describes the gross motor function of children with cerebral palsy.2 The Manual Ability Classification System (MACS/Mini-MACS) is also a five-level classification system that describes manual performance in daily activities.3,4 With a substantial study sample in an observational (non-experimental) setting, we examined the relationships between the various tools, specifically whether 1) changes in COPM performance scores differ by GMFCS and MACS/Mini-MACS levels, and 2) changes in COPM satisfaction scores differ by GMFCS and MACS/Mini-MACS levels. Our findings may have noteworthy implications for practice and future research studies in the field of pediatric rehabilitation.
DESIGN: This is a cross-sectional, observational study utilizing data from the COPM and Los Angeles County (LAC) Medical Therapy Units (MTU) databases. Patients were part of the LAC California Children’s Services Medical Therapy Program and were eligible to be included if they had a diagnosis of cerebral palsy and a COPM completed between July 1, 2017 and June 30, 2018. GMFCS and/or MACS/Mini-MACS severity level were determined prior to the initial COPM assessment.
METHOD: LAC MTU therapists collected demographics and COPM, GMFCS, and MACS/Mini-MACS data as part of their routine patient therapy evaluations. We extracted this information and set our outcomes as to whether the change in performance or satisfaction scores were clinically significant (defined as change scores ≥ 2; yes/no). We used multiple logistic regression models to determine statistical significance and magnitude of associations between the outcomes and severity levels, adjusting for other factors such as age, gender, and length of time between initial and re-assessment on the COPM.
RESULTS: There were 1,009 patients with a completed COPM and a GMFCS level and 1,021 patients with a completed COPM and a MACS/Mini-MACS level. Patients were between the ages of 0 and 18 and there were slightly more females than males in both groups. Both age and GMFCS levels were associated with clinically significant COPM performance change scores (p-value = 0.04 and p-value < 0.01, respectively) but not with clinically significant satisfaction change scores. MACS/Mini-MACS levels were associated with clinically significant COPM performance change scores (p-value < 0.01) but not with age or clinically significant satisfaction change scores.
CONCLUSION: We found that the severity levels on the GMFCS and MACS/Mini-MACS were significantly associated with COPM performance change scores. COPM satisfaction scores were not significantly associated with GMFCS and MACS/Mini-MACS severity levels. This suggests that regardless of severity level therapists can impact patient and family satisfaction. Further investigation could include identifying the types of services (e.g., direct intervention, recommendations, referrals, patient/family education, environmental adaptations) that impact patient/family satisfaction.
IMPACT STATEMENT: Perceived change in satisfaction of occupational performance in children with cerebral palsy can be achieved regardless of severity level in gross motor function and manual ability.
References
1. Law, M., Baptiste, S., Carswell, A., McColl, M. A., Polatajko, H., & Pollock, N. (2014). Canadian Occupational Performance Measure (5th ed.). Ottawa: CAOT Publications ACE.
2. Palisano, R., Rosenbaum, P., Walter, S., Russell, D., Wood, E., & Galuppi, B. (1997). Development and reliability of a system to classify gross motor function in children with cerebral palsy. Developmental Medicine & Child Neurology, 39(4), 214-223. doi:10.1111/j.1469-8749.1997.tb07414.x
3. Eliasson, A., Krumlinde-Sundholm, L., Rösblad, B., Beckung, E., Arner, M., Öhrvall, A., & Rosenbaum, P. (2006). The Manual Ability Classification System (MACS) for children with cerebral palsy: Scale development and evidence of validity and reliability. Developmental Medicine & Child Neurology, 48(7), 549-554. doi:10.1017/S0012162206001162
4. Eliasson, A. & Krumlinde-Sundholm, L. (2016). Mini-MACS: Development of the Manual Ability Classification System for children younger than 4 years of age with signs of cerebral palsy. Developmental Medicine & Child Neurology, 59(1), 72-78. doi:10.1111/dmcn.13162
